AGPCNP ANCC EXAM
Questions and Answers With rationales
2026 update
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Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
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1. A 65-year-old patient presents with a blood pressure of 145/92
mm Hg. According to the ACC/AHA guidelines, which classification
best describes this patient’s blood pressure?
A) Normal
B) Elevated
C) Stage 1 Hypertension
D) Stage 2 Hypertension
Answer: C) Stage 1 Hypertension
Rationale: Stage 1 hypertension is defined as a systolic blood
pressure of 130–139 mm Hg or a diastolic blood pressure of 80–89
mm Hg.
2. A 72-year-old female presents with sudden onset severe right-
sided chest pain that worsens with deep inspiration. She recently
had a total knee replacement. Vital signs are stable. What is the
most appropriate initial diagnostic test?
A) CT Pulmonary Angiography (CTPA)
B) D-dimer
C) Ventilation-perfusion (V/Q) scan
D) Chest X-ray
Answer: A) CT Pulmonary Angiography (CTPA)
Rationale: The patient has pleuritic chest pain and a recent history
of major surgery (high risk for VTE). CTPA is the gold standard for
diagnosing a pulmonary embolism. A D-dimer should not be used in
high-risk patients as it is non-specific.
3. A 55-year-old male with a history of hypertension and type 2
diabetes presents with a lipid panel showing LDL 150 mg/dL, HDL
38 mg/dL, and Triglycerides 180 mg/dL. His 10-year ASCVD risk is
12%. What is the most appropriate intervention?
,A) Lifestyle modifications only
B) Initiate moderate-intensity statin
C) Initiate high-intensity statin
D) Initiate fenofibrate
Answer: C) Initiate high-intensity statin
Rationale: According to ACC/AHA guidelines, patients with diabetes
who are aged 40-75 with an ASCVD risk of greater than 7.5% should
be prescribed a high-intensity statin.
4. A 68-year-old patient with heart failure with reduced ejection
fraction (HFrEF) is currently on lisinopril and metoprolol succinate.
Her heart rate is 68 bpm, and her blood pressure is 110/70 mm Hg.
What class of medication should be added to reduce mortality?
A) Calcium channel blocker
B) Loop diuretic
C) Mineralocorticoid receptor antagonist (e.g., spironolactone)
D) Digoxin
Answer: C) Mineralocorticoid receptor antagonist
Rationale: Guideline-directed medical therapy for HFrEF includes an
ACEi/ARB/ARNI, a beta-blocker, an MRA (like spironolactone), and an
SGLT2 inhibitor. MRAs reduce mortality and morbidity in HFrEF.
Loop diuretics are for symptom relief (volume overload) but do not
reduce mortality.
5. A 60-year-old male presents with acute onset of severe, tearing
chest pain radiating to his back. Blood pressure is 180/110 mm Hg
in the right arm and 140/80 mm Hg in the left arm. You suspect an
aortic dissection. What is the most appropriate next step in
management?
A) Order a CT angiogram of the chest
B) Administer IV nitroprusside
C) Administer a beta-blocker
D) Obtain a transesophageal echocardiogram (TEE)
Answer: C) Administer a beta-blocker
, Rationale: In a suspected aortic dissection, the immediate goal is to
reduce shear stress on the aorta by lowering the heart rate and
blood pressure. A beta-blocker (like esmolol) should be given before
an antihypertensive like nitroprusside to prevent reflex tachycardia.
Imaging is required but stabilizing the patient pharmacologically is
the immediate priority.
6. A 50-year-old female presents with palpitations. Her ECG shows
absent P waves and an irregularly irregular rhythm. Her heart rate is
110 bpm. She has a CHA2DS2-VASc score of 2. What is the most
appropriate management?
A) Rate control with a beta-blocker and aspirin
B) Rhythm control with amiodarone
C) Rate control with a beta-blocker and an anticoagulant
D) Immediate electrical cardioversion
Answer: C) Rate control with a beta-blocker and an anticoagulant
Rationale: The patient has atrial fibrillation. Because she has a
CHA2DS2-VASc score of 2 (indicating a high stroke risk),
anticoagulation is required. As she is hemodynamically stable, rate
control is preferred over rhythm control, and immediate
cardioversion is not indicated.
7. A 75-year-old patient reports progressive dyspnea on exertion
and orthopnea. On exam, you hear an S3 heart sound and bilateral
crackles. An echocardiogram shows an ejection fraction of 35%.
Which symptom is classically associated with this specific type of
heart failure?
A) Worsening dyspnea when lying flat
B) Waking up in the middle of the night gasping for air
C) Lower extremity edema
D) Fatigue and weakness
Answer: A) Worsening dyspnea when lying flat
Rationale: Orthopnea (worsening dyspnea when lying flat) is a
classic sign of left-sided heart failure. Paroxysmal nocturnal dyspnea
Questions and Answers With rationales
2026 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
1. A 65-year-old patient presents with a blood pressure of 145/92
mm Hg. According to the ACC/AHA guidelines, which classification
best describes this patient’s blood pressure?
A) Normal
B) Elevated
C) Stage 1 Hypertension
D) Stage 2 Hypertension
Answer: C) Stage 1 Hypertension
Rationale: Stage 1 hypertension is defined as a systolic blood
pressure of 130–139 mm Hg or a diastolic blood pressure of 80–89
mm Hg.
2. A 72-year-old female presents with sudden onset severe right-
sided chest pain that worsens with deep inspiration. She recently
had a total knee replacement. Vital signs are stable. What is the
most appropriate initial diagnostic test?
A) CT Pulmonary Angiography (CTPA)
B) D-dimer
C) Ventilation-perfusion (V/Q) scan
D) Chest X-ray
Answer: A) CT Pulmonary Angiography (CTPA)
Rationale: The patient has pleuritic chest pain and a recent history
of major surgery (high risk for VTE). CTPA is the gold standard for
diagnosing a pulmonary embolism. A D-dimer should not be used in
high-risk patients as it is non-specific.
3. A 55-year-old male with a history of hypertension and type 2
diabetes presents with a lipid panel showing LDL 150 mg/dL, HDL
38 mg/dL, and Triglycerides 180 mg/dL. His 10-year ASCVD risk is
12%. What is the most appropriate intervention?
,A) Lifestyle modifications only
B) Initiate moderate-intensity statin
C) Initiate high-intensity statin
D) Initiate fenofibrate
Answer: C) Initiate high-intensity statin
Rationale: According to ACC/AHA guidelines, patients with diabetes
who are aged 40-75 with an ASCVD risk of greater than 7.5% should
be prescribed a high-intensity statin.
4. A 68-year-old patient with heart failure with reduced ejection
fraction (HFrEF) is currently on lisinopril and metoprolol succinate.
Her heart rate is 68 bpm, and her blood pressure is 110/70 mm Hg.
What class of medication should be added to reduce mortality?
A) Calcium channel blocker
B) Loop diuretic
C) Mineralocorticoid receptor antagonist (e.g., spironolactone)
D) Digoxin
Answer: C) Mineralocorticoid receptor antagonist
Rationale: Guideline-directed medical therapy for HFrEF includes an
ACEi/ARB/ARNI, a beta-blocker, an MRA (like spironolactone), and an
SGLT2 inhibitor. MRAs reduce mortality and morbidity in HFrEF.
Loop diuretics are for symptom relief (volume overload) but do not
reduce mortality.
5. A 60-year-old male presents with acute onset of severe, tearing
chest pain radiating to his back. Blood pressure is 180/110 mm Hg
in the right arm and 140/80 mm Hg in the left arm. You suspect an
aortic dissection. What is the most appropriate next step in
management?
A) Order a CT angiogram of the chest
B) Administer IV nitroprusside
C) Administer a beta-blocker
D) Obtain a transesophageal echocardiogram (TEE)
Answer: C) Administer a beta-blocker
, Rationale: In a suspected aortic dissection, the immediate goal is to
reduce shear stress on the aorta by lowering the heart rate and
blood pressure. A beta-blocker (like esmolol) should be given before
an antihypertensive like nitroprusside to prevent reflex tachycardia.
Imaging is required but stabilizing the patient pharmacologically is
the immediate priority.
6. A 50-year-old female presents with palpitations. Her ECG shows
absent P waves and an irregularly irregular rhythm. Her heart rate is
110 bpm. She has a CHA2DS2-VASc score of 2. What is the most
appropriate management?
A) Rate control with a beta-blocker and aspirin
B) Rhythm control with amiodarone
C) Rate control with a beta-blocker and an anticoagulant
D) Immediate electrical cardioversion
Answer: C) Rate control with a beta-blocker and an anticoagulant
Rationale: The patient has atrial fibrillation. Because she has a
CHA2DS2-VASc score of 2 (indicating a high stroke risk),
anticoagulation is required. As she is hemodynamically stable, rate
control is preferred over rhythm control, and immediate
cardioversion is not indicated.
7. A 75-year-old patient reports progressive dyspnea on exertion
and orthopnea. On exam, you hear an S3 heart sound and bilateral
crackles. An echocardiogram shows an ejection fraction of 35%.
Which symptom is classically associated with this specific type of
heart failure?
A) Worsening dyspnea when lying flat
B) Waking up in the middle of the night gasping for air
C) Lower extremity edema
D) Fatigue and weakness
Answer: A) Worsening dyspnea when lying flat
Rationale: Orthopnea (worsening dyspnea when lying flat) is a
classic sign of left-sided heart failure. Paroxysmal nocturnal dyspnea
